It’s a hot summer night in the suburbs, most of which you’ve spent on standby for a local baseball game. After clearing up you’re put on a chest pain call a few blocks from your quarters. The local volunteer fire department has a squad on scene which is advising you to, “continue on emergency.”
Upon your arrival you find the patient seated on the porch, on O2 via a non-rebreather, in moderate respiratory distress. The volunteer EMT relays that the patient, a 59 year old male, is having 10 of 10 chest pressure which started yesterday. He’s administered 324 mg of aspirin and withheld nitroglycerin because of the patient’s blood pressure. You’re handed a quick trip sheet as you take over patient care.
- Pulse: 50, weak at the radials
- BP: 80/40
- RR: 24, labored, lungs clear and equal bilaterally
- SpO2: 90% on room air, 94% on 15 L/min via NRB
Your partner starts putting on the electrodes for a 12-Lead while you get a quick history.
- PMHx: hypertension, hypercholesterolemia, GERD
- Medications: lisinopril, lipitor, omeprazole, “vitamins”
- Allergies: penicillin, sulfa drugs, levitra
- Last ins/outs: normal dinner
The patient appears acutely unwell, ashen gray, and diaphoretic. He states the pain is, “pretty constant now,” and that he feels it in, “my shoulder blades and running down my spine”. Your partner hands you the initial 12-Lead:
The EMT helps you and your partner place the patient on your stretcher and move the patient to your unit. Your partner asks you what you think about the 12-Lead and if you’ll need a driver.
- What does the 12-Lead show?
- Should this patient be taken to the local hospital, about 10 minutes away, or the cardiac center, about 25 minutes away?
- Do you need a driver?